The Microbiome of the Gut: Leaky Gut & Chronic Eye Pain, Blepharitis, Rosacea

My previous post on the connection between H. Pylori (a gut bacteria associated with potentially dangerous stomach ulcers) and Chronic Blepharitis alluded to a connection between Leaky Gut and chronic eye inflammation (which can take the form of chronic blepharitis, rosacea, corneal neuropathy, meibomian gland atrophy, chronic eye pain).

Most doctors and particularly eye surgeons know little if anything about the connection between pesticides (ie, Round-Up), gluten (likely treated with multiple pesticides), leaky gut, and eye symptoms.

I remember when most of my colleagues used to make fun of surgeons & doctors who were gluten-free. Even Dr. Perlmutter who wrote Grain Brain & is featured in this Amazon video below was laughed at during neurology meetings.

The connection it seems between H. Pylori & Chronic Blepharitis is oxidative stress likely brought on by pesticides and-or pesticide-treated gluten which leads to a disruption of the delicate microbiome of the gut which can lead to Leaky Gut, which can cause a cascade of undesirable-unbroken-down proteins to leak into the bloodstream which induces inflammation throughout the body.

If a patient has any predisposition to eye issues (ie, add in Accutane, birth control hormones, excessive Contact lens use, rosacea, autoimmune disease, excessive screen time with decreased blink rates, eyelid surgery), this pathway can tip one over the edge to have chronic eye pain or eye symptoms.

This video below if you can access it helps explain the role of pesticides with the rise in gluten-sensitivity and the overall inflammation that can result in an average person or child.

As always, try to listen to the video or blink very frequently. You will not miss much if you just listen to the video.

SLC

https://www.amazon.com/gp/video/detail/B06VVYT9DC/ref=atv_hm_hom_3_c_D4dtpS_2_28

Can Long Term Fasting (for many days and even 2-3 weeks or more) Help Decrease Diabetes, Hypertension, and Help Cure Cancer Patients?

For years my Cardiothoracic-surgeon father has told us the benefits of fasting. That we should fast and do it frequently and stay away from the "poison of carbohydrates and sugar."

This is what I have heard from him for years now.

It seems he is right.

It is still being investigated, and long term fasting should only be done under the supervision of an MD, but I would fast for long periods of time if I had any chronic illness. I currently fast for about 18 hrs routinely, but long term fasting is a whole new world of potential health for some patients.


Video On Fasting if you have Amazon


The basis of the Gerson Anti-Cancer Diet and Dr. Moerman's** diet might be the concept of Fasting.

Can Long Term Fasting (for many days and even 2-3 weeks or more) Help Decrease Diabetes, Hypertension, and Help Cure Cancer Patients?

https://eyedoc2020.blogspot.com/2013/04/your-risk-of-developing-cancers.html

I will try to list the papers on Fasting from Pubmed this week.

SLC


Dr. Cornelius Moerman was a controversial figure of his time in the medical community. It seems his Anti-Cancer diet, though, involved some form of fasting: was he on to something? Maybe!

https://www.cancertutor.com/moerman/

https://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/moerman.html

Lipiflow Procedure: Dr. Sandra Cremers has Lipiflow performed on her eye...

Epinephrine Auto-Injector

Still some doctors do not know that they can write "Epinephrine Auto-Injector" instead of EpiPen for a cheaper equally effective alternative for patients. EpiPen is still very expensive and there are cheaper alternatives.

Epinephrine 1mg/10ml (0.1mg/ml) from Lifeshield is much cheaper: this one is harder to use & you need your own 22G or 30G needle and you should only inject 1/3 of vial at a time, but it is less expensive than the alternatives. I

Stem Cell Use for Dry Eye

Today I saw another patient in her 20's who has had to quit her job because she cannot stand to look at screens. She was a computer programmer working 10hr days in front of some form of electronic screen. This is the 15th patient under the age of 30 who has quit a job because of chronic eye pain. This is unheard of in the eye surgical world. Quitting your job because of eye pain has not been published as far as a I know.

My concern is all the young children under the age of 15 with severe dry eye and meibomian gland atrophy in part due to excessive screen time. What will become of them? Why are the schools not banning screens? How can we quickly get this news spread to all schools globally?

Our Stem Cell protocol for the use to restore the meibomian glands, lacrimal gland, and mucin gland has begun thanks to a very generous donor who has contributed to our research.

We will be following patients to see if we can prove or disprove with the relatively objective test of Meibography to see if autologous stem cells work or not.




The message for everyone, is "Do not ignore your eye symptoms. Get a meibography and eyeMD check if you have any redness, tearing, burning, irritation, foreign body sensation, pain."

Risk of Vision Loss with Cymbalta and Irenka

Yes, there is a risk of bilateral acute angle closure glaucoma with Cymbalta and Irenka.
The risk is rare and usually occurs in patients who have narrow angles and are older. 
Still, be sure you do not have narrow angles (simple Pentacam can check this at your eyeMD's office), before starting Cymbalta and Irenka.
SLC

Ann Pharmacother. 2014 Jul;48(7):936-939. Epub 2014 Apr 14.

Probable Association of an Attack of Bilateral Acute Angle-Closure Glaucoma With Duloxetine.

Shifera AS1, Leoncavallo A2, Sherwood M2.

Author information

Abstract

OBJECTIVE:

To report a patient who had an attack of bilateral acute angle-closure glaucoma (ACG) probably associated with the use of duloxetine.

CASE SUMMARY:

The case reported here involves an 81-year-old Caucasian woman whose past ocular history was unremarkable except for high hyperopia and cataract. The patient developed ocular symptoms 2 days after starting duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI) and was diagnosed with acute ACG. The elevated intraocular pressure (IOP) was successfully lowered with medical treatment, and the patient was advised to discontinue duloxetine. She subsequently underwent laser iridotomy in both eyes, and her IOP remained adequately controlled. A score of 6 was obtained using the Naranjo adverse drug reaction probability scale, suggesting duloxetine as the probable cause of the attack of ACG in this patient.

DISCUSSION:

There are a few previous reports of acute ACG associated with venlafaxine, another member of the class of SNRIs. In addition, there are several reports of ACG associated with members of the related class of selective serotonin reuptake inhibitors (SSRIs)-namely, fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, and escitalopram. The mechanism responsible for the precipitation of ACG by members of these 2 classes of drugs is likely a result of mydriasis caused by their adrenergic effects, weak anticholinergic activities, or the increased levels of serotonin.

CONCLUSION:

Because the SNRIs, including duloxetine, and SSRIs are commonly used in the management of depression or chronic pain, caution is warranted with the use of these drugs in patients with risk factors for ACG.

Autologous Serum (AS) Versus Platelet-rich plasma (PRP)

Platelet-rich plasma (PRP)

Platelet-rich plasma (PRP) contains a higher concentrated of growth factors which stimulate epithelial cells faster than Autologous Serum or whole blood and lead to faster healing. PRP is obtained via centrifugation from whole blood mixed with anticoagulant. Platelets are critically important in the wound-healing process. They translocate rapidly to the wound site and adhere to the damaged tissue, initiating a healing reaction which includes the release of a variety of cytokines and growth factors. Hartwig et al. reported a superior effect on cell growth in platelet releasates in PRP than in Autologous Serum owing to its high content of growth factors 

Platlets contain α-granules which liberate a very high concentration of:

-platelet-derived growth factors, 

-platelet factor IV, 

-transforming growth factor (TGF)-β 

-circulating stem cells 

Thus, PRP is known to harbor higher concentrations of growth factors and can promote effective wound healing and may be better than Autologous Serum in certain patients. 

PRP eye drops can be used to treat ocular surface diseases, such as:

-pain after LASIK (laser-assisted in situ keratomileusis)

-ocular surface diseases

-corneal ulcers

-severe dry eye

-ocular graft-versus-host disease, 

-persistent epithelial defects, 

-neurotropic keratopathy, 

- recurrent epithelial erosions: it reduces the risk of recurrent erosions 

-infectious keratitis

-persistent epithelial defects

Kim, et al. reported improved outcomes with PRP eye drops than Autologous Serum eye drops in patients with persistent epithelial defect after infectious keratitis, for instance (Reference 1).

Autologous Serum (AS)

Autologous Serum (AS) acts as a lubricant on the ocular surface and also supplies several essential substances for the recovery of damaged epithelium. 

It contains:

- vitamin A

- epidermal growth factor (EGF)

-fibronectin and a variety of cytokines  

-circulating stem cells 

These factors help with the proliferation, migration, and differentiation of the ocular surface epithelium cells which helps restore the eye surface to prevent pain or heal a patient from pain.

Autologous Serum eye drops have been used for years for the treatment of:

-ocular surface diseases, 

-corneal ulcers

-severe dry eye, 

-ocular graft-versus-host disease, 

-persistent epithelial defects, 

-neurotropic keratopathy, 

- recurrent epithelial erosions: it reduces the risk of recurrent erosions (Reference 2)

References:

1. Kim KM, Shin YT, Kim HK. Effect of autologous platelet-rich plasma on persistent corneal epithelial defect after infectious keratitis. Jpn J Ophthalmol. 2012;56:544–550.

2. Del Castillo JM, de la Casa JM, Sardina RC, et al. Treatment of recurrent corneal erosions using autologous serum. Cornea. 2002;21:781–783

3. Alio JL, Pastor S, Ruiz-Colecha J, et al. Treatment of ocular surface syndrome after LASIK with autologous platelet-rich plasma. J Refract Surg. 2007

4. Hartwig D, Harloff S, Liu L, et al. Epitheliotrophic capacity of a growth factor preparation produced from platelet concentrates on corneal epithelial cells: a potential agent for the treatment of ocular surface defects? Transfusion. 2004;44:1724–1731

5. Korean J Ophthalmol. 2016 Apr; 30(2): 101–107.

Autologous Platelet-rich Plasma Eye Drops in the Treatment of Recurrent Corneal Erosions

Jun Hun Lee,1 Myung Jun Kim,1 Sang Won Ha,2 and Hong Kyun Kim1